Q&A: Understanding new economic evidence to accelerate malaria elimination in the Asia Pacific

Ben Rolfe, CEO, Asia Pacific Leaders Malaria Alliance
Susann Roth, Senior Development Specialist, Asian Development Bank
Rima Shretta, Associate Director of Economics and Finance, Malaria Elimination Initiative, UCSF Global Health Group

New economic evidence and tools on malaria elimination in the Asia Pacific were just released. What is the goal of this new body of research?

Rima: We had several questions we wanted to answer with this research: What will it cost to eliminate malaria in the Asia Pacific? What is the current funding situation and are there gaps that should be addressed? And what is the potential return on investment, once countries in the region have eliminated the disease? Basically, we wanted to understand whether malaria elimination was possible, what was needed to get us there, and what the potential economic returns would be if elimination is achieved.

Ben: The partnership between the Asian Development Bank (ADB) and the Malaria Elimination Initiative (MEI) is particularly groundbreaking, in that it brings together the analytical depth provided by MEI’s elimination experts and the unique Asia-Pacific perspective provided by the Bank. The analysis of public health issues from a lens that extends beyond health and into financing, fiscal space and efficiency, could have a very substantial effect on how critical services are financed and delivered in the region going forward.

Given current trends in global health funding, why is this research relevant?

Rima: This year’s World Malaria Report shows that overall funding for malaria is declining; our research takes a closer look at funding for malaria elimination specifically. And what we’ve found is global support for malaria elimination is declining much more drastically than funding for malaria more broadly.

Susann: This means that countries will have to work harder to fund malaria elimination programs from domestic resources, which are often tight in the health sector. Part of the new research includes an efficiency analysis tool to support countries in making better investments decisions. Also, if countries request ADB support, we are able to structure loans or blend financing solutions with other partners to fund their malaria elimination programs and achieve their targets while strengthening health systems.

Can you tell us a little bit more about the efficiency tool?

Susann: Developing effective tools for costing and programmatic efficiency analysis is not easy. This is probably one reason why only few have tried it in the past. We are excited that we have been able to contribute to this difficult task, and we believe that these tools will become increasingly useful and relevant for countries as they strengthen their domestic financing for malaria elimination programs.

Rima: The model looks at the mix of interventions the country is using and the mechanisms for delivering these interventions. It reviews technical efficiency, or how current interventions can be sustained at less cost. Countries will be able to use these tools to improve their own programmatic efficiencies and explore opportunities to mobilize new resources outside of donor financing, including from the private sector.

How did the team generate the evidence produced in the study, and what makes it unique?

Rima: Often, this type of data is generated by using a global model to generate estimates in the regions. Our research is unique, however, because it was conducted specially for the Asia Pacific, using national costing data whenever possible. We also use a multi-species model that assesses transmission of two malaria parasite species together, P. falciparum and P. vivax. It is the first model of its kind to do this, which is very exciting.

Ben: This work also provides a substantial starting point for what must become a critical research and policy theme in the region: Protecting core public health services in a region that is both the engine of the global economy, and the source of emerging global health threats.

What is the estimated cost of eliminating malaria in the Asia Pacific?

Rima: We estimate that the cost of eliminating the disease will be USD 29 billion between 2017 and 2030. It is a significant investment, but it is a short-term one. We expect that the cost will be highest in the first few years, and then will start to decrease rapidly. Once countries have eliminated, the cost of maintaining a malaria-free status will be small. What’s more, the expected return on investment (ROI) for elimination in the region is 6 to 1, which is quite large. If the Asia Pacific is able to reach its goal of elimination by 2030, it will see economic returns and savings that will greatly exceed the costs.

Ben: This research looks at the implications of business as usual. It is clear that we will not achieve elimination in the Asia Pacific unless countries intensify their programmatic and resourcing efforts. Elimination can be achieved by 2030, but we will need to move quickly. And if we don’t, malaria will resurge, causing preventable deaths to rise and reversing our investments over the last fifteen years.